周京敏-心包疾病精品医学ppt课件

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1、心包疾病中山医院周京敏GeneralIncidence:low1.5-6%急性心包炎慢性缩窄性心包炎慢性心包积液粘连性心包炎InflammationofvisceralandparietalcardiacsacEffusionChronicrestrictivepericarditisCardiactamponadefluiddyspneaChestpainresolvedfibrousSurgeryHeartFailureeffusionDyspnea,JVdistension,BP￬AcutepericarditisC-Constr-

2、PericNon-specific+++++++Tumor++++TB++++++Radiationtherapy-+++Systemdisease++Physicalandchemicalfactors++EtiologyClinicalManifestation---SymptomsAcutepericarditisC-Constr-PericChestpain++++fibrousPleurotic,Postural－Dyspnea+---+++fluidFastandthin++++GeneralFever－---++－fatig

3、ue－+++ascites－+++wasting－++AcutepericarditisC-Constr-PericFrictionrub++++transient－Enlargementonpercussion－----+++－Edema,ascites－---++－---++++Pulsusparadoxus(>10mmHg)－---+++－---+Jugularveindistension－---+++－---++ClinicalManifestation---SignsAcutePericarditisC-ConstrPericL

4、abfindingsBloodWBCincreaseanemiaAscitesrarelyLeak-outHepatic:normalimpairCK-MborcTNT↑:myocardiuminjurynormalAcutePericC-ConstrPericElectrocardiologyPwaveNormal50%:notchAbnormalqwaveNoWidespreadcalcificationQRSVoltage↓↓ST-TConvex↑exceptinavR(V1)Non-specificArrhythmiaSinust

5、achycardiaAfib,A-VblockAcutePericC-ConstrPericEchofluidNormal,rarelycalcificationChestX-rayEnlargedshadowBottle-likeNormal,Smallandstraight,CalcificationCTorMRIFluidPericardiumthickeningEtiologydiagnosisEchocardiographyAcutePericarditis:Mostimportant,useful,sensitiveConfi

6、rmthediagnosisSemi-quantitythevolumeAssesstheefficacyofmanagementGuidethepericardiocentesisChronicRestrinctivePericarditisnormalPE12-LeadECGfromaPatientwithAcutePericarditis,DemonstratingWidespreadST-SegmentElevationandPR-SegmentDepression.CardiacTamponadeChronicConstrict

7、ivePericarditisAcutePericarditisC-ConstrPericPericardiocentesisEtiologydiagnosisReliefsymptoms__Catheterization__Pressurecurvechange心包镜EtiologydiagnosishardDiagnosisandDifferentialDiagnosisAcutePericarditisC-ConstrPericDiagnosisChestpain+dyspnea+frictionrubAscites+jugular

8、veindistensionDifferentialDiagnosisMIAcuteAbdomenRestrictiveCMLiverdiseaseManagementandPrognosis